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by Yaneer Bar-Yam
Step IV: Accelerate Intake Routing
"Open access" appointments and information routing improve the timeliness of care.

To accelerate the appointments for an initial evaluation, some family practices are adopting a system known as “open access,” designed to facilitate routing and expedite care. In an open access setting, no appointments (or only a limited number) are made significantly in advance. Instead, patients call into the office when they require care and are given an appointment that same day. This system provides an opportunity for a very rapid initial evaluation, allowing for routing decisions to be made literally hours after symptoms manifest.

There is another difficulty that could be addressed with creative use of new technology. Often, the best person to determine whether a particular specialist should be seen is the specialist himself or herself. But a patient moving from specialist to specialist to find out who should provide treatment is not a good strategy. It is inefficient and potentially costly in health consequences.

One approach to solving this problem is to use information routing rather than patient routing. The key is information-gathering and communication. Most of what happens at an initial medical visit to a clinic or primary care physician is a gathering of key information that will serve to determine which specialist should be seen. In information routing, after the initial visit, the information, not the patient, would be forwarded to a number of specialists.

The specialists could rapidly evaluate whether, based upon this limited information, they should be seeing the patient. Or, a specialist might provide a question—if the patient has such and so a symptom or such and so a test result, then they should be seeing the patient, e.g., “If the patient’s ears hurt while the other symptoms occur, she should see me. If not, I’m not the right specialist for this case.”

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